库欣病 (CD) 影响死亡率和生活质量，且长期缓解有限，强调需要更好地识别复发风险。经蝶手术后 CD 缓解的手术或影像学预测因素的确定产生了一些不一致的结果，并且受到单中心、单外科医生或荟萃分析研究的限制。我们试图评估美国垂体中心学术中心的垂体腺瘤及相关疾病 (RAPID) 多中心数据库，以评估是否可以阐明稳健的非激素复发预测因子。纳入了 2011 年至 2023 年接受治疗的 CD 患者。使用单变量和多变量分析评估有和没有复发的 CD 患者的围手术期和长期特征。在 26 名外科医生的 383 名 CD 患者中实现术后缓解，其中 288 名 (75.2%) 在最后一次随访时维持缓解，95 名 (24.8%) 维持缓解。 %) 显示复发（中位复发时间 9.99 ± 1.34 年）。复发患者术后住院时间较长（5 ± 3 vs 4 ± 2 天，P = .002），平均肿瘤体积较大（1.76 ± 2.53 cm 3 vs 0.49 ± 1.17 cm 3 ，P = .0001）等之前的治疗通常失败（31.1% vs 14.9%，P = .001），大部分是之前的手术。肿瘤复发的多变量风险预测模型发现，较年轻的年龄（优势比 [OR] = 0.95，P = .002）和 Knosp 0 级（OR = 0.09，参考 Knosp 4 级，P = .03）可以预防复发。 Knosp 0 至 2 级与 3 至 4 级的比较表明，较低的等级可降低复发风险（OR = 0.27，P = .04）。其他因素，如住院时间、外科医生经验、既往肿瘤治疗以及 Knosp 1、2 或 3 级，在多变量分析中未能达到统计显着性水平。这个多中心研究中心表明，复发的最强预测因素包括肿瘤大小/入侵和年龄。这种见解有助于患者咨询和预测。患者需要长期随访，小肿瘤的早期治疗可能会改善预后。版权所有 © 神经外科医生大会 2024。保留所有权利。

Cushing disease (CD) affects mortality and quality of life along with limited long-term remission, underscoring the need to better identify recurrence risk. The identification of surgical or imaging predictors for CD remission after transsphenoidal surgery has yielded some inconsistent results and has been limited by single-center, single-surgeon, or meta-analyses studies. We sought to evaluate the multicenter Registry of Adenomas of the Pituitary and Related Disorders (RAPID) database of academic US pituitary centers to assess whether robust nonhormonal recurrence predictors could be elucidated.Patients with treated CD from 2011 to 2023 were included. The perioperative and long-term characteristics of CD patients with and without recurrence were assessed using univariable and multivariable analyses.Of 383 patients with CD from 26 surgeons achieving postoperative remission, 288 (75.2%) maintained remission at last follow-up while 95 (24.8%) showed recurrence (median time to recurrence 9.99 ± 1.34 years). Patients with recurrence required longer postoperative hospital stays (5 ± 3 vs 4 ± 2 days, P = .002), had larger average tumor volumes (1.76 ± 2.53 cm 3 vs 0.49 ± 1.17 cm 3 , P = .0001), and more often previously failed prior treatment (31.1% vs 14.9%, P = .001) mostly being prior surgery. Multivariable hazard prediction models for tumor recurrence found younger age (odds ratio [OR] = 0.95, P = .002) and Knosp grade of 0 (OR = 0.09, reference Knosp grade 4, P = .03) to be protective against recurrence. Comparison of Knosp grade 0 to 2 vs 3 to 4 showed that lower grades had reduced risk of recurrence (OR = 0.27, P = .04). Other factors such as length of stay, surgeon experience, prior tumor treatment, and Knosp grades 1, 2, or 3 failed to reach levels of statistical significance in multivariable analysis.This multicenter study centers suggests that the strongest predictors of recurrence include tumor size/invasion and age. This insight can help with patient counseling and prognostication. Long-term follow-up is necessary for patients, and early treatment of small tumors may improve outcomes.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.